BG Medicine Managed Care & Reimbursement Manager/DirectorBG Medicine

THIS JOB HAS EXPIRED

Summary:
Promotes, maintains and assists in the building of managed care relationships which will increase referrals, build steerage opportunities to maximize covered lives. Helps to build relationships and educates managed care payors and their clinical decision makers on the value of Galectin-3 and CardioScore? test. Develop and assists all product reimbursement strategies, implementation and support.

Description:
Independently manage the daily operations of managed care contracting in negotiating, implementing, coordinating and administering managed care contracts to Products and Services on targeted regional and national managed care plans. These duties are to be performed in coordination with and support of managed care field activities, while ensuring compliance with company policy and any legal obligations. This position will require a candidate to provide consultation and strategy for maximizing business associated with Regional and National managed care plans. The candidate will also be responsible for developing and executing all commercialization reimbursement strategies.

Primary responsibilities include:
? Negotiates reimbursement rates, performance programs, and risk arrangements with managed care plans on behalf of BG Medicine
? Manages the implementation of pricing strategies, contract administration, and the review and revision of terms and conditions of all managed care (commercial and Medicare Part B) proposals and contracts ensuring adherence with company pricing guidelines, policies and legal requirements
? Prepares financial and risk analysis to support senior leadership
? Creates and communicates financial and risk terms with internal and external leadership including insurance providers and physician leaders
? Designs models and performs ad hoc analysis for the purpose of understanding the historical and future performance of existing contracts
? Works closely with the customers and business partners to identify systemic issues (e.g., claims underpayments, denials) and develops resolutions that can be addressed in the contract negotiations.
? Monitors, interprets and reports on changes in performance, market trends, health care delivery systems and legislative initiatives which impact managed care efforts (e.g., CMS ACO regs, Healthcare Reform)
? Provides support for the key leadership meetings including: Divisional review meetings and annual budget review and planning.

Qualifications:
? Analytical skills to collect information from diverse sources and summarize the information and data in order to solve problems. Accuracy and attention to detail are required
? Strong interpersonal skills and ability to interact positively with a wide range of constituents.
? Proven excellent written and verbal communication skills. Ability to present information to small and, at times, large audiences.
? Strong organizational and project management skills including development of project parameters, goals, and time lines and outcome measurement.
? Must be able to maintain confidentiality of information.
? Proficiency in Excel, Word and relational databases, Access preferred.
? Ability to function effectively within an ever-changing environment and to meet deadlines and reprioritize as necessary.
? Ability to work both independently and within a team environment and a multi-dimensional environment.
? Creative, flexible, self-motivated, professional must possess sound judgment ability to plan and initiate new activities consistent with achieving service excellence.

Market Understanding: Must have solid understanding of managed care market, including legal issues, business processes, strategies, structure of relationships, etc.